[Tuberculosis in low prevalence countries. Back to the future?]

The incidence of tuberculosis has declined in all European countries in this century but in several countries the decline has come to a stop. Microscopy a.m. Ziehl-Neelsen and culture are still the mainstays in the diagnosis of tuberculosis but new DNA-technics such as PCR and RFLP are increasingly used. The tuberculin test is hitherto the only practically feasible test for identification of subjects infected with M. tuberculosis. BCG is the most used vaccine in the world but the protective mechanisms are not fully understood and the efficacy controversial. Immunotherapy with M. vaccae may be used as an adjuvant to chemotherapy. Few cases of tuberculosis are observed in AIDS-patients in Denmark. Modern standard treatment of tuberculosis comprises a six-month regimen with isoniazid, rifampicin, pyrazinamide and possibly ethambutol. Multidrug resistance in tuberculosis is rare in Western Europe. Chemoprophylaxis with isoniazid is debatable. Patients with smear-positive sputum may be infectious whereas patients with extrapulmonary tuberculosis normally pose no risk.